This dataset includes information related to network adequacy waiver requests filed by major medical health benefit plans. It includes data on physicians, providers, and facilities, other than facility-based physicians and providers. Related datasets are available for major medical (facility-based providers) and vision plans:
• Facility-based Physicians & Providers: Network Adequacy Waiver Request - Facility based Physicians & Providers.This dataset relates to waiver requests for networks used for major medical PPO and EPO plans and includes data on facility-based physicians and providers.
• Vision: Network Adequacy Waiver Request - Vision. This dataset relates to waiver requests for networks used for vision PPO and EPO plans.
Insurers offering health benefits through a preferred or exclusive provider benefit plan (also called PPO and EPO plans) are required to demonstrate that the health insurance network meets Texas network adequacy standards. When a network does not meet these requirements and has a deficiency in a county for a specific physician or provider specialty type, an insurer may apply for a waiver to continue operating within its service area. The commissioner of the Texas Department of Insurance (TDI) may grant the waiver following a public hearing and consideration of relevant testimony and information.
Anyone may attend the public hearing and offer testimony. Learn more about how to submit information related to a waiver request or participate in a hearing here: Network Adequacy Standards Waivers.